What Is Osteoid Osteoma

  • Hania Beg MSc Clinical Drug Development, Queen Mary University, London, UK

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An osteoid osteoma is a tumour of the bone. Although the word “tumour” might cause panic, it is important to note that these types of tumours are benign, meaning they do not have the potential to become cancerous. It is not considered an aggressive tumour, and has a good prognosis after treatment.

Some of the important characteristics and symptoms of this tumour are discussed below. It is important to seek medical attention if you are experiencing any of these symptoms. 

Characteristics of Osteoid Osteoma 

Out of all benign bone tumours, osteoid osteomas account for 10% of them and mostly affect people between the ages of 5 and 25, with a large male predominance.1 It is still uncertain what exactly causes an osteoid osteoma. Still, researchers think that it might be due to injury, abnormal multiplication of cells or inflammation in the affected area. Inflammation causes the growth of blood vessels in the area as well as a multiplication of bone-forming and bone-breaking-down cells. A hard shell is formed around the tumour as well due to the pressure exerted on the bone by the growing tissue. 

This type of tumour is most commonly located in the body’s long bones, such as the thigh or shin bones. They are also less commonly found in the fingers, hand, arms, feet, ankles or spine bones. Osteoid osteomas are not large; they rarely expand more than one inch, and they do not spread to other parts of the body.2 This characteristic makes them much easier to treat. 

An osteoid osteoma has a specific characteristic that is seen on imaging tests, and it helps diagnose it and differentiate it from other tumours. This characteristic is the presence of a central round area known as the nidus, which is an area consisting of tumour cells and blood vessels intertwined with bone tissue. 

Clinical presentation 

The symptoms of an osteoid osteoma are as follows: 

  • The most common symptom is the presence of an ache or dull pain in the affected area, which is often worse at night and unaffected by activity. This pain is effectively relieved by over-the-counter medication such as ibuprofen. 
  • Swelling in affected area
  • Bone deformation or disturbing of child growth 
  • If the tumour is on the leg, there may be unequal leg length, causing limping
  • Abnormal gait 
  • If the tumour involves the spine or occurs near it, there might be scoliosis (abnormal curving or twisting in the spine) or sciatica (compression of a nerve causing back pain which can radiate to the hip and leg)
  • The size of the muscles may decrease (atrophy)
  • If the tumour is located near a joint, it may cause joint stiffness, swelling and pain.

Diagnostic modalities

The first step to diagnose any conditionwill involve your doctor asking you several important questions about your illness to determine further testing and diagnosis. In relation to osteoid osteoma, your doctor will most likely ask you if you have been experiencing any pain and how long you have been having it. Then, they might ask you what you do to relieve that pain, what makes it worse, and whether you've had any recent injury to the affected area. 

Some other diagnostic tests include: 

  • A physical examination and blood tests to test for infections
  • An X-ray is usually the first imaging test conducted for this tumour. The tumour would appear as an area of thickened bone, which will appear white, and the small, central nidus will appear dark

If the x-ray results are inconclusive, your doctor might order a triple-phase bone scan.3 In this test, a radioactive substance is injected into your vein, and a special camera can detect this substance and take pictures of it in your bone, blood and surrounding tissue. Pictures of the affected area are taken twice, once after the substance is injected and another one around three hours later. This test can also help to determine the exact location of the tumour once it has been confirmed. 

  • An MRI or CT can be done. Overall, a CT is preferred because it has proved to provide a more accurate diagnosis for osteoid osteomas1
  • Further testing might involve a biopsy, during which a tissue sample from the affected area is removed and is then sent to the laboratory. The laboratory will then examine this tissue under a microscope to confirm the diagnosis and provide details on the type of tumour present. The tissue is usually removed under the guidance of a CT

Differential diagnosis

There are several other bone conditions that can present with symptoms similar to osteoid osteomas. These can include:2

  • Osteomyelitis (bone infection)
  • Other tumours such as osteoblastoma, osteochondroma, osteosarcoma, Ewing sarcoma, etc
  • Injuries such as stress fractures
  • Bone infarction (decreased blood flow and oxygen to the bone, causing cellular death and damage)

Proper investigations need to be conducted to avoid misdiagnosis of any condition, which can potentially hinder treatment.

Treatment options

Conservative management: In rare cases, an osteoid osteoma may shrink and go away on its own, but this process can take years. They can also sometimes be managed by non-steroidal anti-inflammatory Drugs (NSAIDs) such as ibuprofen. These can be purchased over the counter or through a prescription from your doctor. NSAIDs can help with the pain as well as the inflammation and may also cause tumour shrinkage, but again, this process may take as long as 33 months.4 However, NSAIDs may have some side effects which can limit their long-term use. 

There are also some surgical options available to treat osteoid osteomas:

Curettage: One of the simplest procedures is curettage. This process is done under general anaesthesia, and the surgeon will remove your tumour through a small cut in your skin. The act of curettage or “surgical scraping” will also stimulate the bone to regenerate and grow more bone in the affected area left behind. Some complications which can occur with this surgery include bleeding, infection, damage to nearby bone tissue and longer recovery times.

CT-guided percutaneous radiofrequency ablation: this procedure is less invasive, and there is less damage to the surrounding normal bone. A CT is used to locate the tumour, and then a radiofrequency probe is carefully guided into the tumour. The probe emits an electric current of high frequency that destroys the tumour with heat. This procedure is the treatment of choice for osteoid osteomas, and it has a high success rate of 90%, as all the tumour cells are removed in one sitting.2 There are some complications associated with this procedure, such as superficial skin burns, neuropathy or cellulitis (infection of the skin and underlying tissue). 

Prognosis and complications

There are some complications which can occur if an osteoid osteoma is left untreated and does not go away on its own. If it occurs on the leg, it can cause the leg bones to elong, resulting in an unequal leg length.5 This can lead to limping and unstable gait. Similarly, osteoid osteoma can cause scoliosis if located near the spine or some other physical deformity depending on its location. 

After appropriate treatment, people diagnosed with osteoid osteomas have a good prognosis. After a brief period of recuperation following any surgeries, they can live normal and full live. Although they may require regular follow-ups with the doctor. Recurrence is also a rare phenomenon. 

Ongoing research and advancements 

There exists a minimally invasive procedure for the successful treatment of osteoid osteomas, and it is called CT-guided percutaneous radiofrequency ablation. This procedure also has a very high success rate, and it has been used as the treatment of choiceover more traditional surgical options such as curettage. 

In 2010, another successful treatment option was introduced, which is known as cryoablation.6 In this process, a narrow needle is inserted into the tumour and is essentially frozen using carbon dioxide or argon gas. After the tumour has thawed, it is again frozen and this repetition causes destruction of the tumour. In 2014, microwave ablation was also introduced and this method uses microwave frequency to heat and destroy the tumour.6

These newer methods have proven to be successful without destroying the nearby normal bone tissue. 

Summary

This article may have given you the assurance that osteoid osteoma is not a terrible or untreatable disorder. It is benign with no risk of progression to cancer and it also does not spread to other parts of the body. It can reoccur later in life, but that is a rare event. 

The main symptom you may notice is pain in the affected area, which is worse at night and relieved by painkillers. It can cause other symptoms, which include a deformity of the surrounding bone, presenting t differently according to its location. The most common location is the leg, which can be either the thigh or shin.

This tumour is diagnosed via imaging modalities and can be similar to other disorders therefore it needs to be properly investigated. At times, the tumour may simply go away on its own or be effectively treated with painkillers. However, these options take a long time. Surgical options are quicker and have proved to be safe as well as successful. Future and continued research should be done to provide even better treatment options for people suffering from this disorder. 

References

  • Dookie AL, Joseph RM. Osteoid osteoma. In: StatPearls [Internet] [Internet]. StatPearls Publishing; 2023 [cited 2023 Nov 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537279/
  • Napora J, Wałejko S, Mazurek T. Osteoid osteoma, a diagnostic problem: a series of atypical and mimicking presentations and review of the recent literature. Journal of Clinical Medicine [Internet]. 2023 Apr [cited 2023 Nov 21];12(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095250/
  • Dinh T, McWhorter N. Triple phase bone scan. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 21]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK535390/
  • Yokouchi M, Nagano S, Shimada H, Nakamura S, Setoguchi T, Kawamura I, et al. Early complete remission of osteoid osteoma with conservative medical management. Pediatr Rep [Internet]. 2014 Mar 4 [cited 2023 Nov 22];6(1):5311. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977163/
  • Reif TJ, Matthias J, Fragomen AT, Rozbruch SR. Limb length discrepancy and angular deformity due to benign bone tumors and tumor-like lesions. J Am Acad Orthop Surg Glob Res Rev [Internet]. 2021 Mar 10 [cited 2023 Nov 22];5(3):e00214. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954373/
  • Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A, et al. Osteoid osteoma: an updated review of epidemiology, pathogenesis, clinical presentation, radiological features, and treatment option. In Vivo [Internet]. 2021 Aug [cited 2023 Nov 22];35(4):1929. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286494/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hania Beg

MSc Clinical Drug Development, Queen Mary University, London, UK

Hania is a medical doctor (MBBS), with a MSc in Clinical Drug Development. She has got extensive medical knowledge with prior experience in the Heathcare sector and an in dept understanding of drug development and pharmaceuticals. She is ICH-GCP certified with a special interest in medical writing and research.

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